Oral Pentoxifylline in the Treatment of Venous Leg Ulcers: a Meta-Analysis

10.26686/wgtn.16920913.v1 ◽

2021 ◽

Author(s):

◽

Andrew B Jull

Keyword(s):

Adverse Effects ◽

Meta Analysis ◽

Vascular Diseases ◽

Compression Therapy ◽

Sensitivity Analyses ◽

Leg Ulcers ◽

Venous Ulceration ◽

Venous Leg Ulcers ◽

Compression Bandaging ◽

Randomised Controlled

<p>Compression bandaging improves rates of healing in people with venous ulceration. Some ulcers appear resistant to compression therapy and may benefit from adjunctive therapy. Pentoxifylline is known to improve circulation, but individual trials have failed to conclusively demonstrate its effectiveness in venous ulceration. The objective of this meta-analysis was to assess the effectiveness of pentoxifylline as an adjunct to compression bandaging in the treatment of venous leg ulcers. The CENTRAL registers of the Cochrane Peripheral Vascular Diseases and Wounds Groups were searched - each register is routinely updated by extensive searches of electronic databases, handsearching of relevant journals and conference proceedings, and contact with product companies and experts in the field. The drug's manufacturer was contacted and the references of review articles and all obtained trials were scrutinised for further citations. Randomised controlled trials published in any language comparing pentoxifylline and compression with placebo in adult participants with venous ulceration were included. Trials must have reported a meaningful objective outcome (rates of healing, proportions healed, time to healing). Details from eligible trials (independently selected by two reviewers) were extracted and summarised by one reviewer. A second reviewer independently verified extracted data. Eleven clinical trials were identified. Five trials compared pentoxifylline with placebo (compression standard therapy). Six trials were excluded. Pentoxifylline and compression was more effective than placebo and compression (RR 1.30, 95% C1 1.10-1.54) and was robust to sensitivity analyses. The greater number of adverse effects (46 reports) occurred in the pentoxifylline group, although this was not significant (RR 1.12, 95% C1 0.77-1.62); 34 percent of adverse effects were gastro-intestinal. Seven of 21 reported withdrawals were for adverse effects. In conclusion, pentoxifylline appears an effective adjunct to compression bandaging in the treatment of venous ulcers. The absence of cost-effectiveness data suggests it not be employed as a routine adjunct, but it could be considered as for those patients not responding to compression therapy alone. The majority of adverse effects are likely to be tolerated by patients.</p>

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Neurovascular changes after four-layer compression bandaging in people with chronic venous leg ulcers

Phlebology The Journal of Venous Disease ◽

10.1258/026835507780346123 ◽

2007 ◽

Vol 22 (2) ◽

pp. 49-55 ◽

Cited By ~ 4

Author(s):

R Ogrin ◽

P Darzins ◽

Z Khalil

Keyword(s):

Wound Healing ◽

Wound Repair ◽

Statistical Significance ◽

Sensory Nerve ◽

Compression Therapy ◽

Clinical Problem ◽

Leg Ulcers ◽

Venous Leg Ulcers ◽

Perfusion Measurement ◽

Compression Bandaging

Objectives: Venous leg ulcers represent a major clinical problem, with poor rates of healing. Ideal treatment is compression bandaging. The effect of compression on neurovascular tissues involved in wound repair is unclear. This study aims to assess the effect of four-layer compression therapy (40 mmHg) on neurovascular function and wound healing in people with chronic venous leg ulcers – 15 people (55 years or older) with venous leg ulcers for more than six weeks. Methods: Basal microvascular perfusion measurement (MPM), oxygen tension (tc pO2) measured at sensor temperatures of 39°C and 44°C and sensory nerve function using electrical cutaneous perception thresholds (ECPT) at 5, 250 and 2000 Hz (corresponding to C, A δ and A β fibres) were assessed adjacent to the ulcer site, and at a mirror location on the non-ulcerated limb. Testing was undertaken before and after therapy for 5–12 weeks of four-layer compression bandaging. Results: There was significant improvement in tc pO2 at 44°C and ECPT at 2000 Hz ( P<0.05) compared with pre-intervention. Changes in basal MPM, tc pO2 at 39°C and ECPT at 5 and 250 Hz after compression therapy did not reach statistical significance. Conclusion: Four-layer compression bandaging in people with venous leg ulcers improved some components of neurovascularture in people with chronic venous leg ulcers. Whether this improvement has contributed to wound healing in this study requires further investigation.

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Compression therapy for chronic oedema and venous leg ulcers: AndoFlex TLC Calamine

British Journal of Nursing ◽

10.12968/bjon.2019.28.12.s32 ◽

2019 ◽

Vol 28 (12) ◽

pp. S32-S37 ◽

Cited By ~ 1

Author(s):

Marie Todd

Keyword(s):

Compression Therapy ◽

Lifestyle Changes ◽

Wound Management ◽

Leg Ulcers ◽

Older Population ◽

Venous Leg Ulcers ◽

Compression Bandaging ◽

Patient Morbidity ◽

Cyclical Process ◽

Psychosocial Morbidity

The prevalence of venous leg ulcers and chronic oedema is increasing because of the rise in the older population who have comorbidities. Managing and living with these conditions is extremely costly in resource and human terms and there is often a cyclical process of ulceration, healing and recurrence, resulting in significant physical and psychosocial morbidity. Identifying those at risk and advising on lifestyle changes to prevent progression of these conditions will help in avoiding high wound management and compression costs, nursing input and associated patient morbidity. Compression bandaging is the linchpin in managing these conditions and it must be started as early as possible. However, many patients find it difficult to tolerate bandaging because of issues such as pain, the inability to wear shoes and itch. Therefore, if compliance is to be achieved, it is important to select a compression bandaging system that addresses the issues that patients have difficulty with. AndoFlex TLC Calamine is a compression bandaging system that deals with many of these problems, and is easy to apply and remove. Testimonials by practitioners treating patients with chronic oedema, ulceration and/or skin problems will demonstrate the benefits and effectiveness of AndoFlex TLC Calamine.

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Meta-analytic approaches to determine gender differences for delayed healing in venous leg ulcers

Phlebology The Journal of Venous Disease ◽

10.1177/0268355515616702 ◽

2016 ◽

Vol 31 (10) ◽

pp. 744-752 ◽

Cited By ~ 1

Author(s):

Xiao-Lei Tang ◽

Hong-Lin Chen ◽

Fang-Fang Zhao

Keyword(s):

Gender Difference ◽

Odds Ratio ◽

Healing Rate ◽

Meta Analysis ◽

Sensitivity Analyses ◽

Leg Ulcers ◽

Odds Ratios ◽

Venous Leg Ulcers ◽

Delayed Healing ◽

Meta Regression Analysis

Objective The aim of this analysis was to perform a meta-analysis evaluating gender difference of delayed healing risk in patients with venous leg ulcers. Methods We searched the PubMed and Web of Knowledge from their inception to 4 July 2015. The meta-analysis of pooled odds ratio and 95% confidence interval for venous leg ulcers healing risk were calculated. Results Twelve studies with 4453 patients were included in the meta-analysis. The pooled odds ratio for healing rate stratified by gender was 1.055 (95% CI 0.955–1.165; Z = 1.05, p = 0.292) by fix-effects model. The Begg's test (z = 2.67, p = 0.007), the Egger's test (t = 4.00, p = 0.003), and asymmetric funnel plot suggested there was significant publication bias. Subgroup analysis showed the pooled odds ratios were 1.048 (95% CI 0.945–1.162; Z = 0.88, p = 0.376) in prospective studies and 1.439 (95% CI 0.757–2.736; Z = 1.11, p = 0.266) in retrospective studies. Sensitivity analyses by only pooled adjusted odds ratios showed the pooled odds ratio was 1.049 (95% CI 0.946–1.163; Z = 0.91, p = 0.365), which indicated the results of meta-analysis were robust. Meta-regression analysis showed the healing rate odds ratio stratified by gender was not related with healing rate (t = 0.73, p = 0.484). Conclusion Our meta-analysis indicates that no gender difference existed for delayed healing in venous leg ulcers. Our results may be also useful in developing a risk score for failure of venous leg ulcers to heal.

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Prescribed exercise regimen versus usual care and hypochlorous acid wound solution versus placebo for treating venous leg ulcers: study protocol for a randomised controlled trial (Factorial4VLU)

BMJ Open ◽

10.1136/bmjopen-2020-043420 ◽

2021 ◽

Vol 11 (2) ◽

pp. e043420

Author(s):

Andrew Jull ◽

Angela Wadham ◽

Chris Bullen ◽

Varsha Parag ◽

John G M Parsons ◽

...

Keyword(s):

Randomised Controlled Trial ◽

Usual Care ◽

Hypochlorous Acid ◽

Controlled Trial ◽

Compression Therapy ◽

Trial Registration ◽

Leg Ulcers ◽

Venous Leg Ulcers ◽

Exercise Regimen ◽

Randomised Controlled

IntroductionCompression is the mainstay of treatment for venous leg ulcers (VLUs) and there are few effective adjuvant treatments. There is only observational evidence supporting the use of hypochlorous acid (HOCl) as a topical wound solution on VLU and some limited randomised evidence for the effect of a prescribed regimen of exercise.Methods and analysisThe Factorial4VLU trial is a pragmatic, blinded, factorial randomised controlled trial, with 380 participants receiving either a prescribed exercise regimen compared with usual care and either active HOCl wound solution or placebo wound solution at each dressing change for up to 24 weeks. All participants will receive compression therapy. The primary outcome is the proportion of participants with healed VLU at 12 weeks after randomisation as adjudicated by blinded review of ulcer photographs. Secondary outcomes are proportion healed at 24 weeks, time to healing, estimated change in ulcer area, change in 2-Minute Walk Test, change in health-related quality of life, incidence of infection and incidence of all-cause adverse events. If either of the interventions shows a statistically significant positive difference on healing outcomes, cost-effectiveness will be modelled using a health service perspective.Ethics and disseminationThe Factorial4VLU trial received ethical approval from the Northern B Health and Disability Ethics Committee. We plan to publish the results within 1 year of trial completion and will include the results on the trial registration page.Trial registration numbersAustralia and New Zealand Clinical Trials Register (http://www.anzctr.org.au) (ACTRN12620000116921); Universal Trial Number (WHO) (U1111-1236-2997).

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Four layer bandage compared with short stretch bandage for venous leg ulcers: systematic review and meta-analysis of randomised controlled trials with data from individual patients

BMJ ◽

10.1136/bmj.b1776 ◽

2009 ◽

Vol 338 (apr29 1) ◽

pp. b1776-b1776 ◽

Cited By ~ 1

Keyword(s):

Systematic Review ◽

Randomised Controlled Trials ◽

Meta Analysis ◽

Controlled Trials ◽

Leg Ulcers ◽

Venous Leg Ulcers ◽

Randomised Controlled

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Increasing competence in compression therapy for venous leg ulcers through training and exercise measured by a newly developed score—Results of a randomised controlled intervention study

Wound Repair and Regeneration ◽

10.1111/wrr.12899 ◽

2021 ◽

Vol 29 (2) ◽

pp. 261-269

Author(s):

Kerstin Protz ◽

Joachim Dissemond ◽

Daniela Karbe ◽

Matthias Augustin ◽

Toni Maria Klein

Keyword(s):

Intervention Study ◽

Compression Therapy ◽

Leg Ulcers ◽

Venous Leg Ulcers ◽

Randomised Controlled

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Effect of different compression bandaging techniques on the healing rate of venous leg ulcers: a literature review

British Journal of Community Nursing ◽

10.12968/bjcn.2020.25.sup6.s20 ◽

2020 ◽

Vol 25 (Sup6) ◽

pp. S20-S26

Author(s):

Emily Fulcher ◽

Neil Gopee

Keyword(s):

Quality Of Life ◽

Healing Rate ◽

Cost Effective ◽

Compression Therapy ◽

Leg Ulcers ◽

Venous Leg Ulcers ◽

Compression Bandaging ◽

Search Terms ◽

Compression Bandages

Venous leg ulcers (VLUs) are a common health problem in older adults, for which the widely used method of treatment includes compression therapy. There are various compression bandages and hosiery systems available for use, but it remains unclear as to which types of compression systems are most effective in enabling healing of VLUs. This study aimed to determine which type of the two most commonly used compression bandaging (four-layer and two-layer) is more effective in providing complete ulcer healing of VLUs. Key search terms were identified using the PICO (population, intervention, comparison, outcome) model, with distinct inclusion and exclusion criteria, in a strategic search of electronic databases (e.g. CINAHL and MEDLINE) along with wider sources, including Google Scholar. More studies favoured the four-layer compression system than two-layer for providing better healing rates in the treatment of VLUs, but two-layer bandaging tends to provide a better quality of life and may be more cost-effective, although comorbidities and other factors also need to be considered. In choosing the type of compression bandage for the management of leg ulcers, the healing rate achieved by the chosen bandage needs to be carefully monitored, while also taking into consideration other factors such as the quality of life for the patient.

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